MEDICARE: NORTHEAST OHIO WOMENS CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1255989554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST OHIO WOMENS CENTER LLC

Provider Business Mailing Address
First Line	:	2127 STATE RD
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44223-1427
Country	:	US
Telephone Number	:	330-923-4009
Fax Number	:	330-926-1486

Provider Business Practice Location Address
First Line	:	2127 STATE RD
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44223-1427
Country	:	US
Telephone Number	:	330-923-4009
Fax Number	:	330-926-1486

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	SHERRI GROSSMAN
Credential	:
Telephone Number	:	330-923-4009

Provider Enumeration Date	:	08/29/2019
Last Update Date	:	08/29/2019

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